Public Release: 

Behavior management programs help seniors with chronic illnesses sleep better

Rush University Medical Center

Seniors with chronic illnesses who have trouble sleeping can benefit from a behavior modification program, according to a study conducted by sleep researchers at Rush-Presbyterian-St. Luke's Medical Center in Chicago. The findings will be published in an upcoming issue of the journal Psychology and Aging.

In the study, three groups consisting of 38 older adults with chronic illnesses such as cardiovascular disease, arthritis or lung disease were randomly assigned to one of three treatment groups. One group received classroom cognitive behavioral treatment (CBT), the second group was given home audio relaxation treatment (HART), and the third group received delayed treatment.

After four months of treatment, 54 percent of the CBT group reported clinically significant sleep improvements four months after treatment while 39 percent in the HART group realized statistically significant changes and 6 percent in the control group improved. The areas of sleep measured included sleep efficiency, time awake after sleep onset and total time in bed.

The behavioral classroom intervention consisted of eight-hour weekly group sessions that train individuals to reset their "sleep clock" by adhering to a regular sleep period, curtail daytime naps, avoid activities that make it difficult to fall asleep, and to stay in bed only when drowsy or sleeping.

The HART group consisted of seven commercially produced audiotape recordings derived from a program created for the U.S. Air Force to train pilots and shift workers to sleep better. HART was used over a period of six weeks and the tapes combined progressive muscle relaxation, breathing relaxation, cognitive relaxation, cognitive retraining and nature sounds. It also included instruction in techniques that are similar to those employed in the CBT intervention.

Delayed treatment control group participants completed three in home assessments at intervals that matched to treatment groups and offered HART intervention at the end of the six months.

Seniors with chronic illnesses (such as coronary artery disease, diabetes, osteoarthritis, high blood pressure, high cholesterol levels etc.) have higher rates of insomnia than their healthy counterparts of the same age groups, but these groups of seniors are understudied in behavioral treatment research. Several large clinical trials have established that these techniques are highly effective for healthy older adults.

Bruce Rybarczyk, PhD, an associate professor at Rush Medical College, and colleagues measured the participants' sleep experiences using a number of methods, including sleep logs kept by each participant and actigraphy, which is a wrist monitor that records intensity and frequency of movement.

He pointed out the results of the study show that seniors with chronic illness may be able make substantial improvements in their sleep without resorting to medication.

"Regardless of which method works best, it is hoped that seniors with these chronic illnesses can better control their own sleep without introducing medications as many of these patients already take several drugs to provide care for their other medical conditions," said Rybarczyk. He also noted that "there is a strong preference among older adults to use sleep medications as a last resort and on a short-term basis only. These techniques will give older adults an important new option."


The initial study was funded by a grant from the AARP Andrus Foundation and the National Institute on Aging (NIA). Currently, Rybarczyk and colleagues are conducting a 4-year NIA sponsored study to replicate these findings with a larger group of participants. Both a classroom and an improved home treatment program are being tested. The Older Adult Sleep Improvement Study (OASIS) is currently enrolling adults who are age 55 and older with sleep difficulties. Individuals must also have at least one of three chronic medical conditions: coronary artery disease, osteoarthritis, or chronic obstructive pulmonary disease. Volunteers are being paid up to $200 for participation in the study. Individuals interested in the OASIS program can call 312-942-8173 for more information.

Rush-Presbyterian-St. Luke's Medical Center encompasses the 824-bed Presbyterian-St. Luke's Hospital (including Rush Children's Hospital), the 110-bed Johnson R. Bowman Health Center and Rush University. Rush University, which today has 1,271 students, is home to Rush Medical College, one of the first medical schools in the Midwest. It also includes one of the nation's top-ranked nursing colleges, the Rush College of Nursing, as well as the College of Health Sciences and the Graduate College, which offer graduate programs in allied health and the basic sciences. Rush is noted for bringing together patient care and research to address major health problems, including arthritis and orthopedic disorders, cancer, heart disease, mental illness neurological disorders and diseases associated with aging. The medical center is also the tertiary hub of the Rush System for Health.

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